Posttraumatic stress disorder in general intensive care unit survivors: a systematic review☆
Received 22 March 2008; accepted 28 May 2008. published online 31 July 2008.
Abstract
Objective
Our objective was to summarize and critically review data on the prevalence of posttraumatic stress disorder (PTSD) in general intensive care unit (ICU) survivors, risk factors for post-ICU PTSD and the impact of post-ICU PTSD on health-related quality of life (HRQOL).
Methods
We conducted a systematic literature review using Medline, EMBASE, Cochrane Library, CINAHL, PsycINFO and a hand-search of 13 journals.
Results
Fifteen studies were eligible. The median point prevalence of questionnaire-ascertained “clinically significant” PTSD symptoms was 22% (n=1104), and the median point prevalence of clinician-diagnosed PTSD was 19% (n=93). Consistent predictors of post-ICU PTSD included prior psychopathology, greater ICU benzodiazepine administration and post-ICU memories of in-ICU frightening and/or psychotic experiences. Female sex and younger age were less consistent predictors, and severity of critical illness was consistently not a predictor. Post-ICU PTSD was associated with substantially lower HRQOL.
Conclusions
The prevalence of PTSD in ICU survivors is high and negatively impacts survivors' HRQOL. Future studies should comprehensively address how patient-specific factors (e.g., pre-ICU psychopathology), ICU management factors (e.g., administration of sedatives) and ICU clinical factors (e.g., in-ICU delirium) relate to one another and to post-ICU PTSD. Clinicians caring for the growing population of ICU survivors should be aware of PTSD risk factors and monitor patients' needs for early intervention.
aDepartment of Psychiatry and Behavioral Sciences, Harborview Medical Center, University of Washington School of Medicine, Box 356896, Seattle, WA 98104, USA
bSection of Pulmonary, Critical Care and Respiratory Services, Washington Hospital Center, Washington, DC 20817, USA
cDepartment of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA
dDivision of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
eDepartment of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
☆ Dr. Needham is supported by a Clinician-Scientist Award from the Canadian Institutes of Health Research and by the National Institutes of Health (Acute Lung Injury SCCOR Grant # P050 HL73994). Dr. Bienvenu is supported by a Career Development Award from the National Institutes of Health (K23 MH64543).
ABSTRACT